Patients undergo chest surgery for a variety of reasons including coronary artery bypass, tumor removal, lung and heart transplants. While it is sometimes possible to use less invasive surgical techniques, many of these procedures require gaining access by opening up the chest at the breastbone. There are three basic incisions used to gain access: full sternotomy, partial sternotomy and thoracotomy. The type of incision used depends on the procedure and the general health of the patient. The most common incision is a full sternotomy. During a full sternotomy, the surgeon makes an incision down the center of the chest. The breastbone is divided and held open with a device called a retractor. When the surgery is completed, the doctor reattaches the breastbone with stainless steel wire and sutures the skin. The incision is covered with sterile dressings.
This sternum functions as the anterior stabilizing force for all of the ribs. As a result, a sternotomy destabilizes the previously closed circle of the ribs, thoracic spine, and the sternum. There is significant pain associated with sternal healing.
Care of the lungs is important in order to avoid pneumonia following any surgical procedure involving anesthesia. It is especially important following heart surgery. The surgery itself sometimes involves the lungs or the sacs around the lungs. In addition, if a patient is on the Heart-Lung Machine, the lungs are deflated during the surgery. This frequently causes lungs to create more mucous, making the small air sacs on the outside of the lungs more easily closed. Accordingly, coughing and deep breathing are often necessary during recovery to open the small airsacs and to remove the extra mucous. If the airsacs stay closed and mucous builds up, pneumonia can easily develop. The necessary coughing and deep breathing are frequently very painful following sternotomy.
Sternal pain during coughing and deep breathing may be decreased by splinting the site. Most commonly, the patient hugs a pillow, folded blanket or towel or similar to the chest during deep breathing or coughing so as to apply a compressive force to the site. While somewhat effective in reducing pain, it is suboptimal since the force is applied normal to the sternum and does not decrease the tangential (separating) force on the healing sternum.
Other splinting devices are presently available for decreasing the separation force on the sternum during coughing and deep breathing. The “Cardiothoracic Harness” and “Cardiothoracic Bra” by AztecHeart, Inc. (Oroville, Calif.) are two circumferential devices which stabilize the chest of patients following sternotomy. However, these devices are overly complex and can be painful to apply and adjust on patients who are elderly, obese or have dementia. The “Heart Hugger™” sternotomy support harness by Heart Hugger, Inc. (Los Gatos, Calif.) is a circumferential device which is not closed in the front, but rather has a handle portion attached to the circumferential strap on each side of the frontal gap. However, this device too is deficient as the tangential force is not applied to the ribcage continuously but rather is applied by the patient as necessary, by pulling the handle portions toward each other so as to decrease the frontal gap. The device is well suited to patients with good arm strength, but may not be suitable for patients who are obese, elderly, have dementia, or are incapable of grasping and applying force to the handle portions.
Thus, there is a remaining need in the art for a simple, passive splinting system for median sternotomy patients.